title: Glucose abnormalities associated with impaired nocturnal fall in blood pressure in normotensive severely obese patients.
abstract: BACKGROUND
  The purpose of this study was to identify factors affecting the nocturnal decline in blood pressure (BP) in severe obesity.
  
  
  METHODS
  Clinical, biochemical, polysomnographic data, glucose tolerance status, and body fat composition were obtained in 82 candidates for bariatric surgery (mean age: 40 (11) years; BMI: 46 (4)kg/m(2)). To determine the nocturnal BP fall we used 24-h ambulatory BP monitoring to measure the magnitude (Δ) of nocturnal decline, the % day-night systolic BP (SBP) and diastolic BP (DBP), dipper status and nocturnal hypertension (HT).
  
  
  RESULTS
  Twenty-three percent of patients had nocturnal HT. Sixty percent had non dipper status, of which 95% had nocturnal HT. No specific factors were associated with the average 24-h SBP and DBP. Having glucose abnormalities was of primary importance for all variables evaluating nocturnal BP decline independent of daytime BP levels and severity of obesity. In comparing patients with or without glucose tolerance abnormalities, the night-time SBP and DBP were significantly higher and the Δ nocturnal decline and % day-night in both SBP and DBP were significantly lower in those with glucose tolerance abnormalities. In an adjusted multivariate model, having both glucose abnormalities and nocturnal HT remained associated with non dipper status with an OR of 3.13 (95% CI 1.11-8.87, p=0.03) and 14.93 (95% CI 1.77-125.62, p=0.001), respectively.
  
  
  CONCLUSIONS
  In normotensive severely obese patients, non dipper status and nocturnal HT are common, and the presence of glucose abnormalities was the primary variable associated with impaired nocturnal fall in BP.
authors.affiliation: Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain. lflores@clinic.ub.es
authors.forename: Lilliam
authors.initials: L
authors.lastname: Flores
authors.forename: Marcela
authors.initials: M
authors.lastname: Janka
authors.forename: Silvia
authors.initials: S
authors.lastname: Canivell
authors.forename: Amanda
authors.initials: A
authors.lastname: Jiménez
authors.forename: Josep
authors.initials: J
authors.lastname: Vidal
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology* / Q000601:surgery
keywords: Bariatric surgery; Circadian blood pressure; Dipper status; Normotension; Severe obesity